DOI QR코드

DOI QR Code

Long-term safety of PEG 4000 in children with chronic functional constipation: A biochemical perspective

  • Bae, Sun-Hwan (Department of Pediatrics, Konkuk University Medical Center)
  • Received : 2010.03.18
  • Accepted : 2010.06.03
  • Published : 2010.07.15

Abstract

Purpose: To evaluate the long-term safety of polyethylene glycol (PEG) 4000 in children with constipation, particularly the biochemical aspects of safety. Methods: Medical records were evaluated, and 100 children, who had been taking PEG 4000 for more than 6 months, and who had been under clinical and biochemical monitoring, were enrolled. Ages; $6.11{\pm}3.12$ years, Duration of therapy; $16.93{\pm}7.02$ months, dose of PEG 4000; $0.72{\pm}0.21g/kg/d$. Results: None of the children complained of clinical adverse effect. The first biochemical test was performed at 8.05 months after beginning of PEG 4000. Serum phosphate (SP) value was high in 10 children, and leucopenia was noted in one child. The second test was performed in 44 children at 7.57 months after the first test. The SP value was high in four children, including the three children whose initial SP value was high and one new child. Six out of 10 children with high initial SP value became normal and one was lost. Hypernatremia was noted in one child. The third test was done in 15 children at 7.5 months after the second test. The SP value of the new child from the second test was high, but became normal after finishing treatment. Two out of 3 children with high SP value at the second test became normal and one was lost. The fourth test was done in 2 children few months after the third test. All of the results were normal. There were no relation between duration of therapy and hyperphosphatemia, or between dose of PEG 4000 and hyperphosphatemia. Conclusions: PEG 4000 is safe for long-term therapy in children with constipation with respect to biochemical parameters.

Keywords

References

  1. Loening-Baucke V. Constipation and encoporesis. In: Wyllie R, Hyams J, editors. Pediatric gastrointestinal and liver disease. 3rd ed. Philadelphia: W.B. Saunders, 2006:177-91.
  2. Rahhal R, Uc A. Functional constipation. In: Kleiman RE, Sanderson IR, Goulet O, Sherman PM, Mieli-Vergani G, Shneioder BL. editors. Walker's pediatric gastrointestinal disease. 5th ed. Hamilton: BC Decker Inc., 2008:675-82.
  3. Kim YM, Choi SY, Bae SH, Ahn YM. A clinical study of chronic functional constipation in children treated for more than five months. Korean J Pediatr 2004;47:1186-92.
  4. So HS, Bae SH, Yoon HS, Hwang JS. Efficacy and safety of Polyethylene glycol (PEG) with electrolytes for disimpaction in children with chronic functional constipation. J Korean Pediatr Soc 2003;46:1089-94.
  5. Ingebo KB, Heyman MB. Polyethylene glycol-electrolyte solution for intestinal clearance in children with refractory encoporesis. Am J Dis Child 1988;142:340-4. https://doi.org/10.1001/archpedi.1988.02150030114035
  6. Youssef NN, Peters JM, Henderson W, Shultz-Peters S, Lockhart DK, Di Lorenzo C. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr 2002;141:410-4. https://doi.org/10.1067/mpd.2002.126603
  7. Loening-Baucke V, Krishna R, Pashankar DS. Polyethylene glycol 3350 without electrolytes for the treatment of functional constipation in infants and toddlers. J Pediatr Gastroenterol Nutr 2004;39:536-9. https://doi.org/10.1097/00005176-200411000-00016
  8. Dupont C, Leluyer B, Amar F, Kalach N, Benhamou PH, Mouterde O, et al. A dose determination study of polyethylene glycol 4000 in constipated children: factors influencing the maintenance dose. J Pediatr Gastroenterol Nutr 2006;42:178-85. https://doi.org/10.1097/01.mpg.0000189349.17549.a9
  9. Lee JH, Lee R, Bae SH. Efficacy and safety of electrolytes-free polyethylene glycol (PEG) 4000 for disimpaction in children with chronic functional constipation. Korean J Pediatr 2008;51:391-5. https://doi.org/10.3345/kjp.2008.51.4.391
  10. Lee SH, Bae SH. Maintenance dose of electrolyte free polyethylene glycol (PEG) 4000 in Korean children with chronic functional constipation. Korean J Pediatr 2007;50:1212-6. https://doi.org/10.3345/kjp.2007.50.12.1212
  11. Loening-Baucke V. Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr 2002;34:372-7. https://doi.org/10.1097/00005176-200204000-00011
  12. Pashankar DS, Loening-Baucke V, Bishop WP. Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children. Arch Pediatr Adolesc Med 2003;157:661-4. https://doi.org/10.1001/archpedi.157.7.661
  13. Michail S, Gendy E, Preud'Homme D, Mezoff A. Polyethylene glycol for constipation in children younger than eighteen months old. J Pediatr Gastroenterol Nutr 2004;39:197-9. https://doi.org/10.1097/00005176-200408000-00014
  14. Dupont C, Leluyer B, Maamri N, Morali A. Joye JP. Fiorini JM, et al. Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr 2005;41:625-33. https://doi.org/10.1097/01.mpg.0000181188.01887.78
  15. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Child functional gastrointestinal disorders: Child/adolescent. Gastroenterology 2006;130:1527-37. https://doi.org/10.1053/j.gastro.2005.08.063
  16. Rose M, Jacob LS. Seizure associated with use of visicol for colonoscopy. N Engl J Med 2002;347:295-6.
  17. Schroppel B, Segerer S, Keuneke C, Cohen C, Schlondorff D. Hyponatremic encephalopathy after preparation for colonoscopy. Gastrointest Endosc 2001;53:527-9. https://doi.org/10.1067/mge.2001.113274
  18. Baylis PH. Vasopressin and its neurophysin. In: DeGroot LJ, Besser GM, Gahill GF Jr, Marshall JC, Nelson DH, Odell WD, et al., eds. Endocrinology. 2nd ed. Vol.1. Philadelphia: W.B. Saunders, 1989:213-29.
  19. Clark JH, Russel GJ, Fitzgerald JF, Nagamori KE. Serum beta-carotene, retinol, and alpha-tocoperol levels during mineral oil therapy for constipation. Am J Dis Child 1987;141:1210-2.
  20. Sharif F, Crushell E, O'Driscoll K, Bourke B. Liquid paraffin: A reappraisal of its role in the treatment of constipation. Arch Dis Child 2001;85:121-4. https://doi.org/10.1136/adc.85.2.121
  21. Contiguglia SR, Mishell JL, Klein MH. Electrolyte disorder. In: Friedman HH, editor. Problem oriented medical diagnosis. 3rd ed. Boston: Little, Brown and Company Inc., 1983:250-6.
  22. Webster R, Didier E, Harris P, Siegel N, Stadler J, Tilbury L, et al. PEGylated proteins: Evaluation of their safety in the absence of definitive metabolism studies. DMD 2007;35:9-16.

Cited by

  1. Guidelines for the Treatment of Constipation vol.57, pp.2, 2010, https://doi.org/10.4166/kjg.2011.57.2.100
  2. Are constipation drugs effective and safe to be used in children?: a review of the literature vol.11, pp.1, 2010, https://doi.org/10.1517/14740338.2011.604631
  3. Functional constipation in childhood: current pharmacotherapy and future perspectives vol.14, pp.1, 2013, https://doi.org/10.1517/14656566.2013.752816
  4. Conventional Laxatives vol.88, pp.1, 2010, https://doi.org/10.3904/kjm.2015.88.1.1
  5. Flixweed vs. Polyethylene Glycol in the Treatment of Childhood Functional Constipation: A Randomized Clinical Trial vol.25, pp.2, 2010, https://doi.org/10.5812/ijp.425
  6. Comparison Between the Cassia Fistula`s Emulsion With Polyethylene Glycol (PEG4000) in the Pediatric Functional Constipation: A Randomized Clinical Trial vol.18, pp.7, 2016, https://doi.org/10.5812/ircmj.33998
  7. Functional constipation in children: challenges and solutions vol.8, pp.None, 2010, https://doi.org/10.2147/phmt.s110940
  8. Efficacy and Safety of Combined Oral and Enema Therapy Using Polyethylene Glycol 3350-Electrolyte for Disimpaction in Pediatric Constipation vol.20, pp.4, 2010, https://doi.org/10.5223/pghn.2017.20.4.244
  9. Macrogol (polyethylene glycol) 4000 without electrolytes in the symptomatic treatment of chronic constipation: a profile of its use vol.34, pp.7, 2010, https://doi.org/10.1007/s40267-018-0532-0
  10. Subtype classification of functional constipation in children: polyethylene glycol versus lactulose vol.62, pp.7, 2010, https://doi.org/10.1111/ped.14235